Provider Demographics
NPI:1710477872
Name:BLATTNER, JENNAE C (MS, OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JENNAE
Middle Name:C
Last Name:BLATTNER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:MS
Other - First Name:JENNAE
Other - Middle Name:C
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTRL
Mailing Address - Street 1:3153 E CRYSTAL WATERS DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 WILEY RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MI
Practice Address - Zip Code:49406-5108
Practice Address - Country:US
Practice Address - Phone:269-857-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist